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1649615154 NPI number — MYLAH NICOLE MAHON-DAVENDA NP

NPI Number: 1649615154
Health Care Provider/Practitioner: MYLAH NICOLE MAHON-DAVENDA NP

Information about “1649615154” NPI (MYLAH NICOLE MAHON-DAVENDA NP) exists in 1649615154 in HTML format HTML  |  1649615154 in plain Text format TXT  |  1649615154 in PDF (Portable Document Format) PDF  |  1649615154 in an XML format XML  formats.

NPI Number : 1649615154 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649615154",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAHON-DAVENDA",
    "FirstName": "MYLAH",
    "MiddleName": "NICOLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MAHON",
    "OtherFirstName": "MYLAH",
    "OtherMiddleName": "NICOLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "NP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "141 DAYTON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DANVERS",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01923-1016",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "781-608-1968",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "565 TURNPIKE ST STE 85",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTH ANDOVER",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "01845-5936",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "978-519-4114",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/10/2013",
    "LastUpdateDate": "12/19/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LA2100X",
          "TaxonomyName": "Acute Care Nurse Practitioner",
          "LicenseNumber": "RN2277802",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "RN2277802",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "RN2277802",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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